Keywords:
Multicentre study, Case-control study, Retrospective, Tissue characterisation, Diagnostic procedure, MR, Neuroradiology peripheral nerve, Genital / Reproductive system female, Genitourinary
Authors:
A. Francavilla1, P. milillo2, A. N. Cintoli2, C. Bristogiannis2, L. P. Stoppino2, R. Vinci2, L. Macarini2; 1Foggia /IT, 2Foggia/IT
DOI:
10.26044/ecr2020/C-12311
Conclusion
Sciatica is most commonly due to lumbar spine pathology or sciatic nerve injury and most clinicians look for musculoskeletal pathologies to justify leg pain, but other causes of intraneural mass-like enlargement have to be taken into consideration, such as endometriosis and piriformis syndrome.
The piriformis muscle runs from the anterior sacral vertebrae to the greater trochanter, passing through the greater sciatic foramen [10]. The sciatic nerve is typically placed inferiorly to the piriformis muscle, but occasionally the nerve goes through the muscle fibers: this proximity makes the sciatic nerve vulnerable to irritation and entrapment, giving rise to the Piriformis Syndrome. This is a well-known cause of sciatica, associated with occasional dyspareunia and reproduced on passive internal rotation or adduction of a flexed hip, without evidence of disc disease. Mechanical compression of the sciatic nerve has been reported after prolonged labour, followed by a piriformis hematoma [11]. On MRI the presence of sciatic neuritis can be assessed through neural enlargement, loss of the normal fascicular appearance and perineural/endoneural hyperintensity on fluid-sensitive sequences and enhancement after contrast administration. EM peri-neural diffusion is rare but could give rise to a sciatica-like pain with a cyclic trend in bearing-age women. The gold standard to make a diagnosis is laparoscopy, but MRI examination is useful too above all for the following surgical treatment: early diagnosis and treatment are very important to minimize the nerve damage.